Groups Assail Vision Therapy as Remedy for Learning Disabilities

Action Points

Explain to interested patients that learning disabilities are typically caused by abnormalities in the brain processing of letters and sounds rather than by vision problems.

Note that the statement recommended physicians dispel myths about unproven treatments for learning disabilities when referring patients for further evaluation or support services.

SAN FRANCISCO, July 27 -- Behavioral vision therapy, eye exercises, and colored lenses have no role in treatment of dyslexia and other learning disabilities, according to the American Academy of Pediatrics.

The academy came down hard on these "scientifically unsupported" alternative treatments in a joint statement with the American Academy of Ophthalmology and other vision organizations.

Because learning disabilities are difficult to treat and have long-term consequences for education and socioeconomic achievement, unproven therapies have become highly visible, Sheryl Handler, MD, of the AAO, and colleagues wrote in the August issue of Pediatrics.

"Ineffective, controversial methods of treatment such as vision therapy may give parents and teachers a false sense of security that a child's learning difficulties are being addressed, may waste family and/or school resources, and may delay proper instruction or remediation," they cautioned.

Co-author Walter M. Fierson, MD, chair of the pediatricians' learning disabilities subcommittee on ophthalmology, argued that the very lack of supporting evidence for these popular alternative treatments carries weight.

"They've been around for decades and the opportunity to prove them has been around for a similarly long period of time," he said. "That they are unproven after all this time gives rise to very serious doubt about their validity."

Dyslexia -- which accounts for 80% of learning disabilities -- should not be classed with secondary problems such as visual disorders, mental retardation, or poor instruction, Dr. Handler's group noted.

Rather, it usually stems from altered brain function in the processing of the sound structure of language, which is why systematic phonetics instruction intervention often works.

Although visual processing in the brain has long been speculated as a cause of dyslexia, they said, "We now know these theories to be untrue."

Visual difficulties related to dyslexia, such as faulty directionality and abnormal saccadic eye movements, are symptoms rather than causes, they emphasized.

Only a small subset of dyslexic patients are affected by problems in the magnocellular visual system -- which is responsive to quick movement and moving objects -- that may blur visual acuity when reading.

Studies have yielded conflicting support for this cause. "At the present, there is insufficient evidence to base any treatment on this possible deficit," the statement concluded.

The joint statement called the literature supporting vision therapy a collection of poorly validated research that relies on anecdote and poorly designed and controlled studies. Any benefits, it said, reflect the placebo effect or the traditional educational remediation with which the therapies are combined.

Overall, visual function and ocular health are the same for children with dyslexia and related learning disabilities as in other children. Notably, children with dyslexia often enjoy playing videogames that make the same intensive demands on the eye.

Physicians and ophthalmologists have a role in periodic vision screenings in this population, as with all children. But they play a more important role in providing further evaluation and support for parents -- and dispelling myths, Dr. Handler's group said.

"This should include discussion regarding the lack of efficacy of vision therapy and other 'alternative treatments' with the parents," they wrote. "Parents need to be informed that dyslexia is a complex disorder and that there are no quick cures."

Remediation programs through the child's school or local specialists should include specific instruction in decoding, fluency training, vocabulary, and comprehension, they recommended.

Children with reading disabilities need to practice reading aloud to a parent or tutor each day. Classroom accommodations might include extra time for or shortened assignments, a separate, quiet room for taking tests, provision of lecture notes, and tutoring.

Diagnosing and treating any specific vision problems will make reading more comfortable, but parents can't expect it to improve decoding or understanding of reading, the writing committee noted.

Dr. Fierson reported no conflicts of interest. Co-authors provided no information on conflicts of interest.

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